Skills Checklist - Med/Surg

15849 N. 71st Street . Suite 100 - Scottsdale, AZ 85254 Toll Free: (877) 280-2600 - Fax: (877) 280-5200

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For the skills listed below please check if you are:
(E) Expert - serves as resource
(P) Proficient - performs daily or weekly
(L) Limited - less than 6 times a year
(N) No Experience - observed only

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Name Date Email

Age Specific
Practice Critera

Newborn (birth -30 Days)		Middle (36-64 years)
Adolescent (12-15years)		Preschooler (3-5 Years
Infant (1month-1year)		Elderly (64 + years )
Young Adults (18-35 years)		School Age Children (5-12) Years
Toddler (1-3 Years)

Cardiovascular

Assessment
	E	P	L	N
Auscultation (rate, rhythm)
Blood Pressure/Non Invasive
Doppler
Heart sounds/murmurs
Pulses Circulation Checks

Equipment & Procedures
	E	P	L	N
Basic 12 Lead interpretation
Basic Arrhythmia interpretation
Lead Placement

Pacemaker
	E	P	L	N
Permanent
Temporary

Care of Patients with:
	E	P	L	N
Abdominal aortic bypass
Aneurysm
Angina
Cardiac Arrest
Cardiomyothapy
Carotid Endertoectomy
Congestive Heart Failure CHF
Femeral-popliteal bypass
Myocarditis
Post Acute MI (24-48 hrs)
Post Angioplasty
Post Cardiac Cath
Post Cardiac surgery
Thrombophlibitis

Medications
	E	P	L	N
Heparin Drip
Oral Anti Coagulants
Oral and IVP antihypertensive
Oral and Topical Nitrates

Endocrine/Metabolic

Assessment
	E	P	L	N
S/S Diabetic Coma
S/S Insulin Reaction

Equipment and Procedures
	E	P	L	N
Blood Glucose Monitoring
Electronic Measuring Device
Performing Finger Stick
Visual Blood Glucose Strip
Indwelling Insulin Pump

Care of Patients With
	E	P	L	N
Diabetes Mellitus
Disorders Of Adrenal Gland (Addison's Disease)
Disorders of Pituitary Gland (Diabetes Insipid us)
Hyperthyroidism (Graves Disease)
Hypothyroidism
Thyroidectomy

Medications (Administration & Teaching)
	E	P	L	N
Insulin
Oral Hypoglycemic
Steroids
Thyroids

Gastrointestinal

Assessment
	E	P	L	N
Abdominal /Bowel sounds
Fluid Balance
Nutritional
Interpretation of Blood therapy

Equipment and Procedures
	E	P	L	N
Administration of tube feeding
Feeding Pump
Gravity Feeding
Saline Lavage
Flexible feeding tube (ex Corpak, Dobhoff)

Management of:
	E	P	L	N
Gastrostomy Tube
Jejunostomy Tube
T-Tube
Placement of Nasogastric Tube
Salem Sump to Suction

Care of Patients with:
	E	P	L	N
Bowel Obstruction
Colostomy / ileostomy
GI bleeding
GI surgery
Hepatitis
Inflammatory bowel disease
Invasive diagnostic testing
Liver failure
Paralytic ileus

Genitourinary/Renal

Assessment
	E	P	L	N
Arterio venous fistula / shunt
Fluid balance

Interpretation of Lab Results
	E	P	L	N
Bun and Creatinine
Electrolytes

Insertion and Care of straight and Foley Catheter
	E	P	L	N
Male
Female

Catheter Care
	E	P	L	N
3-way Foley
Supra-pubic

Bladder Irrigations
	E	P	L	N
Continuous
Intermittent

Specimen Collection
	E	P	L	N
Routine
24 hour

Care of Patients with
	E	P	L	N
Hemodialysis
Nephrectomy
Peritoneal dialysis
Renal Failure
Renal Transplant
TURP
Urinary diversion/ileal conduit Nephrostomy
Urinary Tract Infection

Infectious Diseases

Interpretation of Lab Results
	E	P	L	N
Blood Count

Equipment and Procedures
	E	P	L	N
Fever Management
Isolation

Care of Patients with:
	E	P	L	N
AIDS
Hepatitis
Lyme disease

Neurological

Assessment
	E	P	L	N
Glasgow Coma Scale
Level of Consciousness

Equipment and Procedures
	E	P	L	N
Assist with Lumbar Puncture
Use of hyper / hypothermia blanket

Care of Patients with:
	E	P	L	N
Aneurysm precautions
Basal skull fracture
Closed head injury
Coma
CVA
DTs
Encephalitis
Externalized VP shunts
Menegitis
Neuromuscular disease
Post craniotomy
Seizures
Spinal Cord Injury
Administration of Anti Convulsants

Oncology

Assessment
	E	P	L	N
Nutritional Status
Pain Control

Interpretation of Lab Results
	E	P	L	N
Blood Chemistry
Blood Counts

Equipment and Procedures
	E	P	L	N
Reverse Isolation

Care of Patients with:
	E	P	L	N
Care of Patients with
Bone Marrow Transplant
Fresh oncology surgery
Inpatient Chemotherapy
Inpatient Hospice
Leukemia
Radiation Implant
Medications / Chemotherapy Certified (E=Yes,N=No)

Orthopedics

Assessment
	E	P	L	N
Circulation Checks
Gait
Range of Motion
Skin

Equipment and Procedures
Continuous passive motion devices	E	P	L	N
Traction

Support Devices
	E	P	L	N
Cane
Cervical collar
Gait Belt
Prosthetic
Sling
Transfer Boards
Walker
Wheelchair

Care of Patients with
	E	P	L	N
Amputation
Arthroscopic surgery
Cast
Osteoporosis
Pinned Fractures
Rheumatic Arthritis disease
Total hip replacement
Total knee replacement

Pain Management

Assessment
	E	P	L	N
Pain level / tolerance

Care of Patients with:
	E	P	L	N
Epidural anesthesia /analgesia
IV conscious sedation
Narcotic analgesia
Patient controlled analgesia (PCA pump)

Phlebotomy / IV Therapy

Equipment and Procedures
	E	P	L	N
Administration of Blood /Blood Products
Albumin
Cryoprecipitate
Packed red blood cells
Plasma
Whole Blood
Drawing blood from central line
Drawing venous blood

Starting IVs
	E	P	L	N
Angiocath
Butterfly
Heparin lock

Care of Patients with
	E	P	L	N
Central Line / Catheter / Dresseing
Broviac
Groshong
Hickman
Portacath
Quinton
Peripheral line /dressing

Pulmonary

Assessment
	E	P	L	N
Breath sounds
Rate and work of breathing

Interpretation of lab results
	E	P	L	N
Blood Chemistry
Blood Gases

Equipment and Procedures
	E	P	L	N
Assist with Intubations
Assist with Thoracentesis
Care of patients on a Ventilator
Chest physiotherapy
Incentive spirometry
Oximetry

Airway management devices / suctioning
	E	P	L	N
Endotracheal tube / suctioning
Nasal airway / suctioning
Orophararyngeal / suctioning
Sputum specimen collecting
Tracheotomy / suctioning

Care of patients with a chest tube
	E	P	L	N
Assist with setup
Measuring and emptying
Removal

O2 Therapy & Medication delivery systems
	E	P	L	N
Bag and Mask
External CPAP
Face Masks
Inhalers
Nasal Cannula
Portable O2 Tank
Trach collar

Care of Patients with
	E	P	L	N
Bronchoscopy
COPD
Fresh Tracheastomy
Lobectomy
Pneumonectomy
Pneumonia
Pulmonary Embolism
Thoracotomy
Tuberculosis

Wound Management

Assessment
	E	P	L	N
Skin for impending breakdown
Stasis ulcers
Surgical wound healing

Equipment and Procedures
	E	P	L	N
Air fluidized, low airloss beds
Sterile dressing change
Wound care/irrigations

Care of Patients with:
	E	P	L	N
Burns
Pressure Sores
Staged decubitis ulcers
Surgical wounds with drains
Traumatic wounds

Performance
Evaluation

Certifications		Expiration Date
ACLS
BCLS
TNCC
CCRN
CEN

Computerized Charting System
Medication Administration System

Signature Date